SLPs and Radiologists: Two Perspectives, One View
The heat of August always makes me think about… radiation! More specifically, radiation safety and how it relates to the MBSS. I shared resources on this before, but if you missed them, you can find them here.
To add to that, I thought I would share some insights on the Radiologist’s perspective on what we do (and how we do it). I had the opportunity to attend a few conferences for Radiologists last year, and it was so interesting to attend sessions and hear more about not only “our” procedure, but other procedures – all from a different point of view than I am used to as an SLP.
My Key Takeaways
Standardization is important to Radiologists
If you have ever had the opportunity to observe another radiologic examination, you might have noticed that they follow a consistent procedure. In fact, the American College of Radiology and the Society for Pediatric Radiology have a site/publication dedicated to Practice Parameters and Technical Standards (PP&TS) for procedures. The goal of these PP&TS is to “…promote the safe and effective use of diagnostic and therapeutic radiology…” [and to] “narrow the variability among radiology practices and provide guidance to achieve quality in radiology.”
P.S. In case you didn’t know, there is indeed a PP&TS for the MBSS/VFSS. Reach out to me below if you can’t find it!
Radiologists like to talk shop!
SLPs are not the only ones who like to discuss our work (shocking, I know!). And just like we have some really nice field-related podcasts out there, so do Radiologists. A couple to check out: The Radiology Review Podcast by Matt Covington is a great place to start, because it is intended for Radiologists studying for their board examinations. It is organized and clearly presented, and covers a wide range of topics.
Also, Imaging Today has a variety of episodes on multiple modalities and procedures – and two that are specific to the MBSS/VFSS. One features “our very own” Jo Puntil, MS, CCC-SLP, BCS-S, F-ASHA and her colleague Ivo Hanza, NP. Jo is always fun to listen to, and I love to hear an SLP provide education to Radiologists on how and what we do. Another features David J. DiSantis, MD, FSAR–he discusses multiple fluoroscopy procedures, but he gets into the MBSS around minute 18. The whole episode is worth a listen as he discusses the history of GI imaging – it’s really entertaining.
Radiologists have a wide scope of practice
If this sounds familiar, it should! We as SLPs know how massive our scope of practice can be, and Radiologists have this in common! Their scope is not only the entire body, but it is also a number of different imaging modalities, including X-ray (Radiography & Fluoroscopy), Mammography, Computed Tomography (CT), Magnetic Resonance Imaging (MRI), Ultrasound, Nuclear Medicine and Molecular Imaging (incl. Positron Emission Tomography (PET)), Bone Density Imaging (DEXA), and Image-Guided Interventional Procedures. Radiologists also collaborate with referring physicians to help diagnose medical conditions, monitor disease progression, evaluate treatment effectiveness, and guide patient care.
Bonus Links
I also want to acknowledge the tremendous work Dr. Bonnie Martin-Harris has done to build collaboration with Radiologists and their organizations. From consulting on the ACR-SPR PP&TS for MBSS/VFSS to co-publishing and presenting with Radiologists and serving on a committee with the Society for Abdominal Radiology, she has worked to bridge the gap between our professions. We all want Radiologists to better understand why and how we do what we do, and one of the best ways to strengthen that partnership is to also understand their role, expertise, and perspective.
Here are a few of these works, all of which would be wonderful resources to help advocate with Radiology on implementing best practices:
A radiology resident training initiative that includes a video on the conduction of the MBSS. You will find it under “GERD-GI Fluoroscopy DFP Webinars”. I recommend watching them all to learn more about the bigger picture of fluoroscopy.
A collaborative paper on best practices in MBSS/VFSS:
Martin-Harris B, Canon CL, Bonilha HS, et al. Best practices in modified barium swallow studies. American Journal of Speech-Language Pathology. 2020;29(2S):1078-1093.
Available on the ABSSD, this recording of a multidisciplinary panel is available for ASHA CEs:
From Conflict to Collaborations: Facilitating Conversation with Radiologists during the Modified Barium Swallow Study
The multidisciplinary Blue Ribbon Panel Recommendations for Fluoroscopy Safety for the American College of Radiology (ACR)
A collaborative paper for the journal Abdominal Radiology:
Zarzour J, Revels J, Rao Korivi B, et al. An update on pharyngeal assessment by the modified barium swallow. Abdom Radiol. 2025;50:2414-2425.
Let me know if this was helpful! And if you can’t find the ACR-SPR PP&TS for the MBSS, let me know and I will get it to you!!!
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INDICATIONS AND USAGE | IMPORTANT SAFETY INFORMATION
For Oral Administration. This product should not be used in patients with known or suspected perforation of the GI tract, known obstruction of the GI tract, high risk of aspiration, or hypersensitivity to barium sulfate products. Rarely, severe allergic reactions of anaphylactoid nature have been reported following administration of barium sulfate contrast agents.
VARIBAR® (barium sulfate)
INDICATIONS
VARIBAR® THIN HONEY (barium sulfate) oral suspension, VARIBAR® NECTAR (barium sulfate) oral suspension, and VARIBAR® THIN LIQUID (barium sulfate) oral suspension are radiographic contrast agents indicated for use in modified barium swallow examinations to evaluate the oral and pharyngeal function and morphology in adult and pediatric patients.
VARIBAR® HONEY (barium sulfate) oral suspension and VARIBAR® PUDDING (barium sulfate) oral paste are radiographic contrast agents indicated for use in modified barium swallow examinations to evaluate the oral and pharyngeal function and morphology in adult and pediatric patients 6 months of age and older.
IMPORTANT SAFETY INFORMATION
CONTRAINDICATIONS
These products should not be used in patients with known or suspected perforation of the gastrointestinal (GI) tract; known obstruction of the GI tract; high risk of GI perforation such as those with a recent GI perforation, acute GI hemorrhage or ischemia, toxic megacolon, severe ileus, post GI surgery or biopsy, acute GI injury or burn, or recent radiotherapy to the pelvis; high risk of aspiration such as those with known or suspected tracheo-esophageal fistula or obtundation; known severe hypersensitivity to barium sulfate or any of the excipients of the product used.
WARNINGS AND PRECAUTIONS
Hypersensitivity Reactions Barium sulfate preparations contain a number of excipients, including natural and artificial flavors, and may induce serious hypersensitivity reactions. The manifestations include hypotension, bronchospasm and other respiratory impairments, and dermal reactions including rashes, urticaria, and itching. A history of bronchial asthma, atopy, food allergies, or a previous reaction to a contrast agent may increase the risk for hypersensitivity reactions. Emergency equipment and trained personnel should be immediately available for treatment of a hypersensitivity reaction.
Intra-abdominal Barium Leakage The use of VARIBAR PRODUCTS is contraindicated in patients at high risk of perforation of the GI tract. Administration of VARIBAR PRODUCTS may result in leakage of barium from the GI tract in the presence of conditions such as carcinomas, GI fistula, inflammatory bowel disease, gastric or duodenal ulcer, appendicitis, or diverticulitis, and in patients with a severe stenosis at any level of the GI tract, especially if it is distal to the stomach. The barium leakage has been associated with peritonitis and granuloma formation.
Delayed Gastrointestinal Transit and Obstruction Orally administered barium sulfate may accumulate proximal to a constricting lesion of the colon, causing obstruction or impaction with development of baroliths (inspissated barium associated with feces) and may lead to abdominal pain, appendicitis, bowel obstruction, or rarely perforation. Patients with the following conditions are at higher risk for developing obstruction or baroliths: severe stenosis at any level of the GI tract, impaired GI motility, electrolyte imbalance, dehydration, on a low residue diet, taking medications that delay GI motility, constipation, pediatric patients with cystic fibrosis or Hirschsprung disease, and the elderly. To reduce the risk of delayed GI transit and obstruction, patients should maintain adequate hydration after the barium sulfate procedure. When administering VARIBAR PUDDING, consider the administration of laxatives.
Aspiration Pneumonitis The use of VARIBAR PRODUCTS is contraindicated in patients with trachea-esophageal fistula. Oral administration of barium is associated with aspiration pneumonitis, especially in patients with a history of food aspiration or with compromised swallowing mechanism. Vomiting following oral administration of barium sulfate may lead to aspiration pneumonitis. In patients at risk for aspiration, begin the procedure with a small ingested volume of VARIBAR PRODUCTS. Monitor the patient closely for aspiration, discontinue administration of VARIBAR PRODUCTS if aspiration is suspected, and monitor for development of aspiration pneumonitis.
Systemic Embolization Barium sulfate products may occasionally intravasate into the venous drainage of the GI tract and enter the circulation as a "barium embolus" leading to potentially fatal complications which include systemic and pulmonary embolism, disseminated intravascular coagulation, septicemia and prolonged severe hypotension. Although this complication is exceedingly uncommon after oral administration of a barium sulfate suspension, monitor patients for potential intravasation when administering barium sulfate.
ADVERSE REACTIONS
The most common adverse reactions are nausea, vomiting, diarrhea, and abdominal cramping. Serious adverse reactions and fatalities include aspiration pneumonitis, barium sulfate impaction, intestinal perforation with consequent peritonitis and granuloma formation, vasovagal and syncopal episodes.
You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
Please click here for full Prescribing Information for VARIBAR® THIN LIQUID (barium sulfate) oral suspension.
Please click here for full Prescribing Information for VARIBAR® THIN HONEY (barium sulfate) oral suspension.
Please click here for full Prescribing Information for VARIBAR® NECTAR (barium sulfate) oral suspension.
Please click here for full Prescribing Information for VARIBAR® HONEY (barium sulfate) oral suspension.
Please click here for full Prescribing Information for VARIBAR® PUDDING (barium sulfate) oral paste.
VARIBAR is manufactured by E-Z-EM Canada Inc., for E-Z-EM, Inc., a subsidiary of Bracco Diagnostics Inc., Princeton, NJ 08540.
VARIBAR is a registered trademark of E-Z-EM, Inc.
INDICATIONS AND USAGE | IMPORTANT SAFETY INFORMATION
Do not use in cases of known or suspected esophageal obstruction or to dislodge foreign bodies. Do not use more than the maximum recommended dosage in 24‐hour period. Do not use the maximum dosage of this product for more than two weeks, except under the advice and supervision of a physician.
Talk Soon,
US-VARH-2500014 12/25